There is great uncertainty in the treatment of elderly patients with
acute myeloid leukemia (AML), which leads to great challenges in treatment decision. The aim of this study is to find more suitable induction
therapy and consolidation
therapy for elderly AML patients.
METHODS: After the first induction treatment, the complete remission/or complete remission with incomplete hematologic recovery (CR/CRi) rates in the standard-intensity
chemotherapy group was significantly higher than that in the low-intensity
chemotherapy group (58.2% vs 32.9%, p = 0.003). Compared with the low-intensity
chemotherapy, the incidence of severe
infection in the standard-intensity
chemotherapy was significantly increased (p < 0.001), but the early mortality was comparable. One hundred and seven patients received
minimal residual disease (MRD) examination after the first induction treatment; and MRD was negative accounting for 51.9% in the standard-intensity
chemotherapy group, while only 32.7% in the low-intensity group (p = 0.05). The 2-year-overall survival (OS) of patients in standard-intensity
induction chemotherapy group (37.2%) was slightly higher than that in low-intensity
induction chemotherapy group (23.4%) (p = 0.075). Eighty-one CR/CRi patients received intermediate or high dose
cytarabine (n = 35) or sequential
chemotherapy regimens (n = 46) as consolidation treatment. The 2-year OS and event-free survival (EFS) of patients in the intermediate or high-dose
cytarabine group were significantly higher than those in the sequential
chemotherapy regimens group (73.0% vs 38.5%, p = 0.002; 54.8% vs 35.0%, p = 0.035).
CONCLUSION: Our results showed that standard-intensity
induction chemotherapy can significantly improve the CR rate for elderly AML patients, and does not increase the early mortality; consolidation
therapy with intermediate or high-dose
cytarabine can significantly improve EFS and OS for elderly AML patients achieved CR.